Dermatophytes are among the common fungal agents implicated in superficial skin infections worldwide. They include species of Trichophyton, Microsporum and Epidermophyton. In hot and humid climates of tropical and subtropical regions, the incidence of these pathogens is higher. We present in this article, the epidemiological data regarding the prevalence of different dermatophyte species involved in superficial mycoses in human patients in the state of Himachal Pradesh (India) and different clinical conditions, age and sex of the patients. A total of 202 samples in the form of skin and nail scrapings, hair follicles were collected from different ringworm/tinea conditions which included: Tinea corporis, T. capitis, T. cruris, T. pedis, T. unguium, T. faciei, T. manuum and T. gladiatorum. On culturing, 74 samples (36.6%) were found positive for dermatophyte spp. Trichophyton spp. was the predominant one (98.65% cases) followed by Microsporum gypseum (1.35% cases). However, we did not recover any Epidermophyton spp. Among the Trichophyton spp., T. mentegrophyte was the predominant spp. (63.5%) followed by T. rubrum (35.1%). The male to female ratio of the positive cases was recorded as 63:11. The most effected age group was 21-50 years (64.9%) followed by 1-20 years (28.4%) and above 50 years (6.8%).

There is a lack of evidence to guide the management of cellulitis in the emergency
department (ED). The primary aim of this study was to characterize antibiotic-prescribing
practices for the treatment of cellulitis in Irish EDs. Secondary aims were to identify
patient variables associated with the prescription of intravenous (i.v.) antibiotics
and to describe the utility of three published guidelines for the management of cellulitis
in the ED.This was a multicentre, prospective, observational cross-sectional study of consecutive
patients presenting to six EDs in Ireland over a 1-month period (June 2012).In total, 117 patients were enrolled. Fifty-five percent of all patients (n=65) were
referred from primary care, and emergency physicians prescribed i.v. therapy in 50%
of patients (n=59) overall. Nonpurulent cellulitis accounted for 96.5% of cases (n=113).
Flucloxacillin, either alone or with penicillin V, is the most commonly prescribed
oral antibiotic in patients both referred from primary care and discharged from the
ED. Flucloxacillin with benzylpenicillin is the most commonly prescribed i.v. treatment.
Fever, increasing diameter of infection, and tinea pedis were associated with prescription
of i.v. antibiotics by emergency physicians. The three guidelines examined in this
study recommended oral antibiotic treatment for between 33-44% of patients who were
treated with i.v. antibiotics by emergency physicians.In Ireland, current prescribing practices for CREST 1 and modified CREST 1 and 2 patients
are poorly adherent to guideline recommendations.

A stress fracture of the medial malleolus in adolescent athletes is a rare condition
with poorly defined outcomes. Proper management requires early recognition, with treatment
directed toward the athlete's safe return to their sport. Failure to assess and manage
the fracture properly can result in significant complications, including fracture
progression, delayed healing, nonunion, and chronic pain. We present the case of a
medial malleolar stress fracture in a 14-year-old football player, who was successfully
able to return to competition 4 weeks after surgical treatment. We have also provided
a review of the published data regarding the management of these injuries and recommendations
for returning athletes to competition.

Skin diseases, especially tinea capitis, represent some of the most frequent causes
of morbidity in developing countries. The aim of this study was to examine the prevalences
of fungal infections in schoolchildren in a primary school located in a rural area
in southern Ethiopia and to perform an analysis of the risk factors associated with
tinea capitis.This school-based, prospective cross-sectional study was conducted in October 2012
in Gambo School, Kore, West Arsi, Oromya Region, Ethiopia. Detailed interviews and
dermatological examinations were performed. No laboratory examinations were conducted.A total of 647 students were interviewed and examined. The mean age of these children was 10 years (range: 4-14 years). Of the children examined, 236 had some type of dermatophytosis (prevalence: 36.5%, 95% confidence interval [CI] 32.8-40.3), which represented the most frequent type of skin problem. The prevalence of dermatophytoses was more common in males than in females (42.2% and 30.5%, respectively; P = 0.002), and among pupils aged 5-7 years (46.9%; P < 0.001). A total of 159 (prevalence: 24.6%, 95% CI 21.3-28.1) children had tinea capitis, 56 (8.7%) had tinea pedis, 50 (7.7%) had tinea corporis, and six (0.9%) had tinea unguium. In multivariate analysis, the risk factors for tinea capitis were: age (odds ratio [OR] 0.75, 95% CI 0.69-0.84; P < 0.001), and male gender (OR 2.56, 95% CI 1.69-13.39; P = 0.002).Fungal dermatoses, especially tinea capitis, are common in primary schoolchildren
in rural areas of southern Ethiopia, especially in young boys.

Persons with intellectual disabilities frequently have podiatric conditions. Limited
information exists on their prevalence in international cohorts of Special Olympics
(SO) athletes. Findings from multiple United States (US) venues are compared to those
from athletes screened at the 2011 Special Olympics World Summer Games in Athens,
Greece (ATHENS).Data from Fit Feet screenings from 2096 ATHENS participants was compared to 7192 US
participants.Frequently noted in the ATHENS population were motion restriction in both the ankle
and the first metatarsal phalangeal joint (1st MTPJ), pes planus, metatarsus adductus,
brachymetatarsia, hallux abducto valgus (HAV), onychomycosis, onychocryptosis, and
tinea pedis. ATHENS differed from the US cohort as HAV and restricted ankle joint
and 1st MTPJ joint motion was less frequent. Significantly more tinea pedis, xerosis,
and hyperhidrosis were present in the ATHENS population.SO athletes have a higher prevalence of podiatric structural conditions compared to
the general population, and some vary between ATHENS versus US. Less prevalent in
ATHENS was HAV, and restricted motion in both the ankle and 1st MTPJ. This may reflect
differences due to varied clinical observers. The higher rates of several dermatological
conditions in ATHENS may reflect venue seasonal climate, or social factors.

Fusarium species are emerging causative agents of superficial, cutaneous and systemic human infections. In a study of the prevalence and genetic diversity of 464 fungal isolates from a dermatological ward in Thailand, 44 strains (9.5%) proved to belong to the genus Fusarium. Species identification was based on sequencing a portion of translation elongation factor 1-alpha (tef1-α), rDNA internal transcribed spacer and RNA-dependent polymerase subunit II (rpb2). Our results revealed that 37 isolates (84%) belonged to the Fusarium solani species complex (FSSC), one strain matched with Fusarium oxysporum (FOSC) complex 33, while six others belonged to the Fusarium incarnatum-equiseti species complex. Within the FSSC two predominant clusters represented Fusarium falciforme and recently described F. keratoplasticum. No gender differences in susceptibility to Fusarium were noted, but infections on the right side of the body prevailed. Eighty-nine per cent of the Fusarium isolates were involved in onychomycosis, while the remaining ones caused paronychia or severe tinea pedis. Comparing literature data, superficial infections by FSSC appear to be prevalent in Asia and Latin America, whereas FOSC is more common in Europe. The available data suggest that Fusarium is a common opportunistic human pathogens in tropical areas and has significant genetic variation worldwide.

A 31-year-old immunocompetent male who presented with a 4-year history of extensive
erythematous and scaly plaques involving the abdomen, gluteal and inguen regions with
concomitant tinea pedis and onychomycosis is described. Diagnosis was based on positive
mycological examination and positive histopathologic examination. Species identification
was performed by growth on Sabouraud dextrose agar and by sequencing of the internal
transcribed spacer regions of the rDNA region. The pathogen identified was Trichophyton
rubrum. The same fungal species was cultured from his abdominal, gluteal, foot and
toenail. A combination therapy with systemic terbinafine and topically applied terbinafine
cream was successful. A 1-year follow-up did not show any recurrence of infection.

A positive mycological examination is required before discussion of treatment of onychomycosis.
Onychomycosis is most commonly due to dermatophytes in association with tinea pedis
and/or tinea manuum. It is a catched infection. Candida onychomycosis is a rare opportunistic
infection and onychomycosis due to non-dermatophytic moulds is very rare as a "chance
mishap". The treatment of dermatophyte onychomycosis takes each infected part of the
nail into account. Topical antifungal agents should be reserved for mild to moderate
onychomycosis. Systemic antifungal agents are required to severe onychomycosis. In
all cases, removal of infected nail parts is useful to facilitate the penetration
of antifungal drugs and eradication of reinfection sites may be done to prevent recurrences
and relapses. In primary, Candida onychomycosis treatment with topical antifungal
drugs may be effective but in case of treatment failure, a systemic therapy is required.
Suppression predisposing factors is useful. The treatment of non-dermatophytic moulds
onychomycosis is still a challenge. Except Neoscytalidium spp., which mimic a dermatophytosis,
non-dermatophytic moulds may be isolated from dystrophic nails and it is always difficult
to specify their role as a primary pathogen or as a colonizer of nails. The available
topical and systemic antifungal drugs are not effective against these non-dermatophytic
moulds except itraconazole for onychomycosis due to Aspergillus spp. New therapy such
as light and laser therapy are in evaluation.

Onychomycosis represents about 50% of ungueal pathology. Dermatophytes (especially
Trichophyton rubrum and Trichophyton interdigitale) are the main species involved
in tinea pedis. Yeasts of the Candida (Candida albicans, Candida parapsilosis,...)
genus are predominant on hands and very often associated with ungueal disease and
perionyxis. Fungi other than the classic dermatophytes and yeasts can be rarely isolated
from nail diseases. Among them, species belonging to Scopulariopsis, Aspergillus and
Fusarium genus are mainly found, but their involvement in the disease must be proved.
Other fungi, presenting a special affinity to keratin (pseudodermatophytes), such
as Neoscytalidium dimidiatum (ex Scytalidium dimidiatum) from tropical and subtropical
areas and Onychocola canadensis from Northern America and Europe, are considered as
real pathogens in nail diseases. A multidisciplinary approach, including clinicians
and biologists, is required to confirm the mycosis. This comparative review emphasizes
the importance of histological examination, as well as molecular approaches, which
are very contributive to the diagnosis of onychomycosis. The role of the laboratory
is to identify at the species level the fungus isolated from nail scrapings and to
show its involvement in the ungueal lesions.

The study aims to statistically develop a microemulsion system of an antifungal agent,
itraconazole for overcoming the shortcomings and adverse effects of currently used
therapies. Following preformulation studies like solubility determination, component
selection and pseudoternary phase diagram construction, a 3-factor D-optimal mixture
design was used for optimizing a microemulsion having desirable formulation characteristics.
The factors studied for sixteen experimental trials were percent contents (w/w) of
water, oil and surfactant, whereas the responses investigated were globule size, transmittance,
drug skin retention and drug skin permeation in 6h. Optimized microemulsion (OPT-ME)
was incorporated in Carbopol based hydrogel to improve topical applicability. Physical
characterization of the formulations was performed using particle size analysis, transmission
electron microscopy, texture analysis and rheology behavior. Ex vivo studies carried
out in Wistar rat skin depicted that the optimized formulation enhanced drug skin
retention and permeation in 6h in comparison to conventional cream and Capmul 908P
oil solution of itraconazole. The in vivo evaluation of optimized formulation was
performed using a standardized Tinea pedis model in Wistar rats and the results of
the pharmacodynamic study, obtained in terms of physical manifestations, fungal-burden
score, histopathological profiles and oxidative stress. Rapid remission of Tinea pedis
from rats treated with OPT-ME formulation was observed in comparison to commercially
available therapies (ketoconazole cream and oral itraconazole solution), thereby indicating
the superiority of microemulsion hydrogel formulation over conventional approaches
for treating superficial fungal infections. The formulation was stable for a period
of twelve months under refrigeration and ambient temperature conditions. All results,
therefore, suggest that the OPT-ME can prove to be a promising and rapid alternative
to conventional antifungal therapies against superficial fungal infections.